What is Dressler's Syndrome?

Two months after suffering a heart attack, Ginger, a friend, was proud of the healthy lifestyle she had adopted. She said she was now careful about her diet, had lost 15 pounds, and followed an exercise plan. However, while cooking one night, the 42-year-old just didn't feel well, then experienced chest pain and shortness of breath. She was shocked to find out that she was suffering from Dressler's syndrome.

Overview

The Mayo Clinic indicates that Dressler's syndrome is an inflammation of the pericardium, the sac that surrounds the heart. The disorder is also known as postpericardiotomy, post-myocardial infarction syndrome, and post-cardiac injury syndrome.

This condition takes its name from cardiologist William Dressler (1890-1969), according to a posting on the Emory University School of Medicine site. Dressler graduated from the University of Vienna Medical School, then moved to New York to practice medicine in 1938.

While recent cardiac treatment improvements have made Dressler's syndrome less common than it was decades ago, a patient can suffer a recurrence. In the United States, estimated frequencies range from 2 to 30 percent for patients who have surgery that includes opening the pericardium, Medscape reports.

Causes

During a myocardial infarction - a heart attack - a piece of heart muscle can get damaged and/or die. The response of the body's immune system is to try to accomplish a cleanup and repair of the heart.

However, sometimes the immune response is too strong, and the patient experiences excessive inflammation of the pericardium. When the resulting symptoms persist for weeks or even months, the diagnosis is Dressler's syndrome, Diagnosisheart.com indicates.

Patients who have not had a heart attack but who have undergone heart surgery such as implantation of a pacemaker are at elevated risk for this condition. So are those with a heart injury like blunt trauma or a stab wound.

Signs and Symptoms

The classic symptoms of Dressler's syndrome are chest pain, a general feeling of malaise, fever, fatigue, and shortness of breath. Unlike the tight, crushing, and sometimes radiating pain of a heart attack, the pain associated with Dressler's tends to be sharp and stabbing. Patients report that it worsens with breathing and lying down and improves when they sit or stand. Some affected individuals experience a cough, a heart rate of more than 100 beats a minute, and a feeling of anxiety.

Two rare but serious complications are cardiac tamponade, in which pressure from fluid makes the heart work too hard to pump blood efficiently, and constrictive pericarditis, which develops when inflammation of the pericardium over time causes it to thicken or become scarred, also reducing the heart's ability to pump at maximum efficiency. Some patients might also suffer from pleurisy, an inflammation of the membranes surrounding the lungs, or pleural effusion, a buildup of pleural fluid around the lungs, while experiencing Dressler's syndrome.

Diagnosis

A physician examining a patient with Dressler's symptoms conducts a number of exams and tests after reviewing the health history. Listening to the heart with a stethoscope can reveal a scratchy, high-pitched sound known as a friction rub, a sign of an inflamed pericardium. The heartbeat might sound muffled or distant if a significant amount of fluid has accumulated.

An echocardiogram creates an image of the heart, making it possible to see if fluid is collecting around the organ. An electrocardiogram measures electrical impulses in the heart and can reveal pressure on it.

Treatment

The primary objectives of treatment are pain management and reducing inflammation. Commonly prescribed medications include aspirin, ibuprofen (Advil®, Motrin®), and naproxen (Aleve®).

When this therapy isn't effective, doctors might prescribe colchine, an anti-inflammatory with potentially significant side effects, or corticosteroids. Unfortunately, corticosteroids carry a risk of serious side effects and can actually prevent timely healing following a heart attack or cardiac surgery.

Patients who suffer complications from Dressler's syndrome sometimes require invasive treatments. One is draining excess fluid around the heart using a procedure known as pericardiocentesis and is performed under a local anesthetic. Sometimes it's necessary to remove the pericardium due to thickening or scarring that cuts the patient's heart function. In most cases, the heart functions properly without a pericardium. This procedure is known as a pericardiectomy.

Sources:

http://www.mayoclinic.com/health/dresslers-syndrome/DS00666

http://medicine.emory.edu/education/meows/2011/04/April_17.cfm

http://emedicine.medscape.com/article/891471-overview

http://www.diagnosisheart.com/pericarditis-dresslers-syndrome-and-pericardial-window/